Nurse practitioners could be poised to fill primary care gap

(Reuters Health) - With the U.S. lurching toward a severe shortage of primary care physicians, nurse practitioners may be poised to fill the void - but only if more can be convinced to live in underserved areas and laws in some states loosen up, a new study suggests.

Researchers found that in California, where shortages of primary care physicians are starting to be felt, nurse practitioners more often reside in counties where there are already plenty of doctors, according to the report in Health Affairs.

“California is often the laboratory for the rest of the country,” said lead author Joanne Spetz, a professor of economics at the University of California, San Francisco. “But in this context, it’s behind where some other states are with respect to the nurse practitioner workforce.”

The state has two major barriers to nurse practitioners shouldering some of the primary care burden, Spetz said.

First, there are not many training programs in underserved areas. And second, Spetz added, “California is the only Western state that requires written standardized procedures for nurse practitioners to practice and prescribe. When you have that, nurse practitioners are able to do less in practice even if they are side by side with a physician. And they’re less likely to relocate to rural areas.”

California isn’t the most restrictive state when it comes to oversight of nurse practitioners, Spetz said. “In some states you have to be within a certain number of miles from the doctor,” she added. “In some, a doctor has to review 10 percent of the charts.”

But nearly half of states already allow nurse practitioners to go without such oversight.

“Currently 22 states allow nurse practitioners to practice and prescribe without any physician oversight,” Spetz said. “Some require temporary oversight, for the first two years for example, and then they can practice without it.”

Nurse practitioners, formally known as Advanced Practice Nurses, hold advanced degrees - either a Master of Science in Nursing or a Doctorate in Nursing Practice – according to Nurse Journal. They are licensed by the state and able to provide many of the clinical services that doctors offer.

In the U.S., the population of nurse practitioners has nearly doubled, from 120,000 in 2007 to 234,000 in 2017, Spetz and her coauthor note. In California, their numbers grew from 14,636 in 2010 to 19,768 in 2017.

The researchers examined data from California’s 2017 Survey of Nurse Practitioners and Certified Nurse Midwives. The survey had been sent to 2,250 certified nurse practitioners, or roughly 11 percent of those in the state, with 1,271 returning completed questionnaires.

There was some good news. Younger nurse practitioners were more likely to live in underserved counties.

Despite the barriers, nurse practitioners could still be in a position to fill the primary care void if only because there are so many more of them than there are physicians, Spetz said. She suggested that some of the demographic problems could be solved by locating training sites in underserved areas and by targeting training programs to more black and Hispanic candidates. People are more likely to settle down where they trained or where they grew up, Spetz noted.

“It’s daunting to think we could have a shortage of primary care physicians in California within the next seven years,” she said. “It’s a great opportunity for nurse practitioners to fill that gap, especially in rural areas and places with underserved populations.”

The impending shortage may prompt nursing schools to offer distance learning programs, said Johnstone, who wasn’t involved in the new research. It’s a way to allow nurses from those areas to get advanced degrees and perhaps continue to practice there.

Johnstone hopes changes aren’t long in coming. “We have a potential to act upon these results and make a difference before the gap is too wide and we can’t overcome it,” she said.